Posts Tagged ‘Health Policies’

Global Health Africa blogger – Ifeoma Ozodiegwu – shares some of her reflections on improving health outcomes in Africa. She is currently based in Zambia.

Here in Zambia, I have spent the past 5 months observing, reading and reflecting on how best to improve the health outcomes in Africa. I am currently obsessed with learning and highlighting best practice ideas to tackle preventable diseases.

It appears to me that part of the answer lies not in solely improving the health sector but in improving all sectors in a country. The death of a hypothetical young mother from undiagnosed HIV is strongly associated to the economic, financial and social structures prevalent within a nation. I am viewing this problem from the angle of poverty and the lack of safety nets that prevented this hypothetical lady from being educated and led her into impoverishment. At this point, she is unable to afford care and consequently, her first point of call when she is ill is the traditional medicine man, who may attribute her illness to spiritual forces.

Health outcomes have deeper roots than an individual’s decision or the state of a health sector. In the words of Dr. Margaret Chan, the WHO Secretary General, “……the threats to health are more numerous, the causes more ominous and the burden more onerous”. Echoing the same sentiment in their treatise on the evolution of health in all policies, IIona Kickbusch and Kevin Buckett write about “wicked problems” in the context of health systems. They define these problems as “difficult to define, may be socially complex, are often multicausal with many inter-dependencies, have no clear solution and are not the responsibility of any one organization or government department”

Consequently, to address the present day health challenges calls for a broader and more collaborative approach by stakeholders – African Governments, donors, health ministries, international and local NGOs. Governments in the region need to create the enabling environment for multi-sectoral collaboration to thrive. Policy-makers can see the results of such collaboration from the Singaporean experience as documented by William Haseltine in his book – Affordable Excellence. In the book, Haseltine writes about an “unusual degree of unity” that existed within the country’s ministries as far back as the 1980s. This unified front created room for discussion and collaboration on multi-sectoral issues and development of policies that “reaches across ministries”. In its 2000 World Health Report, the World Health Organization ranked Singapore as sixth on its overall health system performance ahead of several developed countries.

Involving other sectors to work in public health has the potential to bring about exponential improvements in the health of citizens in African countries. For example, collaborations between ministries of transportation and health could be the first step in addressing the high mortality rate from accidents in Africa. See more about accident statistics in Africa.

Such alliances could result in improved availability and response time of emergency care at frequent accident sites. In addition, research collaboration between both ministries can help determine accident risk factors and develop programs to address them. Indeed, one of the proverbs we are fond of in Africa goes: “If you want to go fast, go alone. If you want to go far, go together”.

The Zambian National Malaria Control Programme appears to be a growing success. Estimates from the Zambian Demographic Health Surveys indicate a 29% reduction in under-5 mortality for the period, 2001-2007. Even more, a research paper in the American Journal of Tropical Medicine and Hygiene highlights the improvements in household and individual adoption of malaria prevention tools such as insecticide treatment nets (ITN) and Intermittent preventive treatment in pregnancy (IPTp). By 2008, 60% of households in Zambia had at least one ITN and over 60% of pregnant women had received 2 or more doses of IPTp. However, an increase in malaria cases was reported in 2010.

Having read bits and pieces of Zambia’s efforts in combating malaria in the news media, I set out to understand and share, from public health literature, some of the factors that were responsible for their public health gains. In part 2, I will examine the implications of these factors, which I call the building blocks, and the challenges that lie ahead for Zambia and other African nations.

The Building Blocks

National Commitment

After the launch of the Roll Back Malaria Partnership in 1998, the Zambia Government put in place structures that demonstrated a commitment to the elimination of malaria. These included the establishment of a ministerial task force to coordinate the development of the 2000-2005 National Malaria Strategic Plan (NMSP) and the founding of the National Malaria Control Centre (NMCC) in 2002. The National Government also went ahead to eliminate taxation on ITNs and on corresponding insecticides while adopting artemesinin- based combination therapy (ACT) as its front-line anti-malaria therapy recommendation.

By 2005, the National Malaria Control Centre set out to reduce malaria incidence and under-5 mortality in five years by 75% and 20% respectively. These goals were set to be achieved through a combination of prevention strategies that included insecticide treated nets (ITN), indoor residual spraying (IRS) and prompt malaria diagnosis and treatment with Rapid Diagnostic Kits and artemesinin-based combination therapy (ACT). Coverage targets outlined in the 2006-2011 NMSP included: greater than 80% of households with an average of 3 ITNS/HH, greater than 80% of pregnant women receiving greater than or 2 doses of IPTp, greater than 80% of pregnant women sleeping under ITN or in a house with IRS, greater than 80% of children under 5 years sleeping under ITN or in a house with IRS and greater than 80% of sick persons treated with effective anti-malarial within 24 hours of onset.

To further along their goals to eliminate malaria, The Zambia Government also increased allocations for the malaria control initiatives. By 2008, budget allocations for malaria from the Zambia Government had come to $25.4 million.

These actions by the Government of Zambia provided evidence of its dedication to eliminating malaria and improving the health outcomes of Zambians.

International community support

Zambia’s efforts to build the infrastructure for national scale malaria control program attracted substantial donor support. Donors included the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the U.S Agency for International Development (USAID), the Bill and Melinda Gates Foundation through the Malaria Control and Evaluation Partnership in Africa (MACEPA), the World Bank, the U.S President Malaria Initiative (PMI), and the World Health Organization. Donations from these international organizations combined with domestic funds from the Zambian Government ensured that crucial aspects of the malaria control program were funded.

However, support for malaria control initiative in Zambia was also the result of a desire by the international community to have a successful model of a national scale malaria control initiative which can be replicated by other countries within the region.

Staying the course

From 2002, Zambia began a nation-wide roll out of insecticide treated nets (ITNs), indoor residual spraying (IRS) and Rapid diagnostic Tests (RDTs) kits. In the following years, efforts were made to expand the distribution of these key aspects of the malaria control program to ensure adequate population coverage. However, the inconsistent nature of donor funding impacted the distribution of bed nets for years 2004 and 2008.

Rollout of ITNs, IRS and RDTs at the National Level

Source: National Bureau of Economic Research

To ensure access to treatment for diagnosed malaria cases, ACTs were made free to all those seeking care within the public health sector.

Data-Informed Decision-Making

Using the National Health Management Information Systems as well as sentinel surveys like the Zambian Demographic and Health Survey (ZDHS) and the Malaria Indicators Surveys, the Zambian Government and its International partners were able to monitor the progress of the nation-wide malaria control efforts.

Some data points captured by these data tracking tools include under-five child malaria mortality, yearly malaria in-patients from all facilities, and distribution, ownership and use of ITNs.

Climatic Advantages

Zambia has 3 distinct seasons within its tropical climate-a hot, rainy season (November-April), a cool dry winter (May-August), and a hot, dry season (September-October). These seasonal variations influenced the transmission of malaria by Plasmodium infected mosquitoes. Mosquitoes were abundant from September to April but markedly reduced during the cold winters from May to August. As a result, efforts to reduce population malaria parasitemia during those winter months may induce reduced transmission during the other months.

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As I watched Social Good Summit 2012 recently held by Mashable, so many questions came to my mind. One of them was: “Is social media being used to change or encourage the development of health or healthy policies in Africa”? Social media has the capacity to galvanize communities, foster discussion and get the attention of policy makers to create healthy policies like smoke-free laws-which are so few in the continent; policies that encourage breastfeeding, and ensure good roads and development within African nations. We have all seen the impact of social media all over the world from the Arab spring to Ushadidi. Also, most social media platforms are quite inexpensive and can be used easily to engage subscribers. With mobile phone technology with web capabilities becoming ubiquitous on the African continent, I do think that there is a huge potential to utilize social media to influence health policy-making on the African Continent.

I could not find any research on the social media and policymaking in Africa. However, I am aware of international organizations that use social media platforms for various forms of health promotion. Yet, what about grassroots organizations? Are you aware of any example of social media being utilized to influence decision-making in the health sector in Africa? Do you think it can be an effective tool? Do let us know your thoughts!

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Global Health Africa was created by two global health professionals – Sophie Okolo and Ifeoma Ozodiegwu – in 2012. With a focus on Africa, these two global health enthusiasts spotlighted unexplored health issues such as autism, elderly abuse, dementia, and neglected tropical diseases on the blog. As their interests evolved, Sophie and ... Continue reading →